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Utilization management is "a set of techniques used by or on behalf of purchasers of health care benefits to manage health care costs by influencing patient care decision-making through case-by-case assessments of the appropriateness of care prior to its provision," as defined by the Institute of Medicine [1] Committee on Utilization Management by Third Parties (1989; IOM is now the National ...
(The Center Square) – New laws go into effect in Illinois Jan. 1 that will put new restrictions on the state’s health insurance industry. Gov. J.B. Pritzker said the Healthcare Protection Act ...
The Illinois Department of Healthcare and Family Services (HFS), formerly the Department of Public Aid, [1] is the code department [2] [3] of the Illinois state government that is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing child support services to help ensure that Illinois children receive financial support from both parents.
Get Covered Illinois is the health insurance marketplace for the U.S. state of Illinois. The exchange enables people and small businesses to purchase health insurance at federally subsidized rates. Since its inception, over 388,179 Illinois consumers have gained health insurance coverage. [1]
An independent medical review (IMR) is the process where physicians review medical cases in order to provide claims determinations for health insurance payers, workers compensation insurance payers or disability insurance payers. Peer review also is used in order to define the review of sentinel events in a hospital environment for quality ...
State Health Insurance Assistance Program (SHIP). If you receive Medicare, find free, unbiased help through your local SHIP program. Consider other credit or loan options. 401(k) loans.
The Affordable Care Act (ACA) established the health insurance rate review program in order to protect consumers from unreasonable rate increases. [1] Through this program, proposed premium increases in the small group and individual markets that are above a threshold amount (ten percent or more, as of February 2014) are reviewed by states or the federal government to determine whether the ...
health insurance for every American4 Mandatory Insurance Requirements ! Provide coverage for all children under the age of 18 ! Universal Responsibility: Requires employers to provide insurance or pay into Health Care General Fund (HCGF). Individuals not covered by employers required to purchase insurance from HCGF5! All Americans
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